Hypnogram: A Call to Action

For the next year one of my goals as president is to ensure that the AASM continues to fight for our members on issues related to insurance coverage and reimbursement for sleep medicine services.

By now you are well aware that many private payers have begun to require utilization management review and preauthorization for diagnostic sleep testing. I understand why these changes have been alarming to many of you. As a practicing sleep medicine clinician, I face the same challenges that confront you.

Recently my predecessor, Samuel Fleishman, MD, made you aware of some of the actions that the AASM has taken on your behalf. For example, we have been challenging insurers such as Cigna, MVP and United Healthcare to improve their processes for OCST contracting and sleep testing preauthorization.

But it’s not enough for us to complain. Quite frankly, the insurers don’t care whether or not we like their policies. What they want to know is how their policies are affecting the quality and cost of patient care.

That is why the AASM recently asked members to complete a preauthorization survey. To be able to represent our membership effectively, we have to be able to quantify how these changes are affecting you. We need data about preauthorization, denials and appeals. If members are encountering inappropriate contracting practices and unjustified denials for in-lab sleep studies, then we need documentation.

Although some members have completed the survey, we still need much more data. Lacking this objective information about how new policies are affecting the practice of sleep medicine, the AASM is going into battle without any weapons when we meet with insurers to discuss your concerns.

It is important for you to remember that the AASM is your professional society. Our success is dependent on your personal involvement and the consistent engagement of all our members. We all have a stake in the future of our field, and we must work together to turn the challenges of today into opportunities for tomorrow.